Summary of best evidence and practice recommendations for nonpharmacological interventions of urinary incontinence in elderly women / 中华健康管理学杂志

Objective:To integrate the best evidence of non-drug intervention of urinary incontinence in elderly women and to formulate practical recommendations.Methods:In this systematic review study, using “elderly woman”,“urinary incontinence”,“bladder training”,“pelvic floor muscle training”,“enuresis”,“leakage of urine” as the key words, the 6S evidence resource pyramid model was used to search in British Medical Journal best practice, Uptodate, World Health Organization, Guidelines International Network, National Institute for Health and Care Excellence, Chinese Medical Association, Scottish Intercollegiate Guideline Network, Registered Nurses Association of Ontario, Cochrane Library, The Joanna Briggs Institute (JBI), New Zealand Guidelines Group, Polish Society of Gynecologists and Obstetricians, PubMed, Embase, Medline, Web of Science, SinoMed, China National Knowledge Infrastructure, WanFang Data, etc. The evidence retrieved included evidence-based knowledge base resources, clinical practice guidelines, expert consensus, systematic review, etc. Data were retrieved from January 1, 2017 to May 1, 2022, and collated from May 2, 2022 to May 25, 2022. Two researchers independently evaluated the quality of literature and extracted data using the AGREE Ⅱ and JBI evidence-based health care center assessment tools. The JBI evidence-based health care center′s evidence pre-rating system and evidence recommendation rating system were applied to rank the evidence; and under the guidance of the evidence structure of JBI, the strength of evidence recommendation was determined and the best evidence was extracted and summarized in combination with the study group discussion and expert opinion.Results:A total of 9 articles were retrieved, including 7 guidelines and 2 systematic reviews; and 6 guidelines were classified as Grade A and 1 as grade B; both 2 systematic reviews were rated as Grade A; 84% (27/32) of the items were evaluated as “Yes”. Evidence were summarized as 34 pieces of best evidence from 6 dimensions, including “overall recommendation, evaluation of type and degree of urinary incontinence, lifestyle change, behavioral therapy, prevention of precipitating factors, intervention in special population”; the flow chart of screening, evaluation, special symptoms, life style and behavior therapy was combed, and the practical suggestions were formed.Conclusions:The overall quality of the literature on non-drug intervention of urinary incontinence in elderly women is high, and the level of evidence is high. Early identification of urinary incontinence types and assessment of disease severity, lifestyle changes, avoidance of predisposing factors and behavioral therapy are the key to non-drug treatment of urinary incontinence in those patients.

Research progress on multicomponent physical exercise for patients with neurocognitive impairment / 浙江大学学报·医学版

Neurocognitive impairment is a group of clinical syndromes characterized by impaired cognitive function and decreased motor ability. Non-pharmacological interventions such as physical exercise have advantages in the treatment of patients with neurocognitive impairment. Multicomponent exercise is a combination of various physical exercises, including strength training, endurance training, balance training and flexibility training, that can improve gait, balance and cardiopulmonary function by increasing muscle mass, strength and endurance in people with neurocognitive impairment, while also reducing the risk of falls in elders. This article reviews the benefits of multicomponent exercise for patients with neurocognitive impairment and its evaluation methods; also describes 4 intervention programs and their clinical application, to provide evidence for clinical practice and promote the application of multicomponent exercise in patients with neurocognitive impairment.

Symptom Management and Factors Related to Nurses’ Attitudes toward Terminally Ill Patients with Congestive Heart Failure

<p>Objectives: This study examined symptom assessments and non-pharmacological interventions to relieve symptoms among heart failure patients, and factors related to nurses’ attitudes towards terminal care. Method: A cross-sectional study was conducted with 180 nurses using a questionnaire. Results: Symptom assessments were conducted about 80% of the times for all 14 symptoms of congestive heart failure. Non-pharmacological interventions, such as adjustment in daily life, consideration of positioning and movement in daily life, and environment adjustment, were frequently conducted. Nurses who attended palliative care seminars indicated more positive attitudes toward terminal care including a positive attitude toward caring for dying persons. Low points in difficulties with terminal care reflected nurses’ knowledge and skills related to high points in positive attitudes toward caring for dying persons. Conclusion: These results suggest that educational programs are required for nurses providing palliative care for patients with heart failure to enhance nurses’ attitudes towards terminal care and to promote palliative care practice. </p>

Recent Advances in Diagnosis and Treatment of Alzheimer's Disease

Alzheimer's disease (AD) is a neurodegenerative disorder in which neuronal loss causes cognitive decline and other neuropsychiatric problems. It can be diagnosed based on history, examination, and appropriate objective assessments, using standard criteria such as the Diagnostic and Statistical Manual of Mental Disorders or the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA). Brain imaging and biomarkers are making progress in the differential diagnoses among the different disorders. The cholinesterase inhibitors, donepezil, rivastigmine and galantamine and N-methyl-D-aspartate receptors antagonist memantine are approved by the US Food and Drug Administration for AD. Recently some acetylcholinesterase inhibitors gained approval for the treatment of severe AD and became available in a higher dose formulation or a patch formulation. Optimal care in AD is multifactorial and it should include early diagnosis and multidisciplinary care with pharmacological and nonpharmacological interventions including exercise interventions, cognitive interventions and maintenance of social networks.

The Effectiveness of Music Therapy for Post-Operative Pain Control among Total Knee Replacement Patients

Pain is an unpleasant sensation that can cause physical and psychological problems for the patient. Despite the pharmacological intervention for reducing pain, it remains as an issue after surgery. Music therapy as non-pharmacological intervention can effect post-operative pain and patients’ requirement of analgesics. The purpose of this study was to determine effect of music therapy on pain after elective total knee replacement (TKR) surgery. This study compared analgesics consumption by patients post-operatively for five days. A Quasi-experimental design with convenience sample of patient with a mean of 64.35 (49-76) who underwent TKR in UKM Medical Centre from May to December 2012 was used. Forty patients were randomly assigned in one of the two groups using a sealed-envelope technique. The experimental group listened to music for five days post-operatively and were on analgesics and control group were treated with pharmacological intervention only. Pain was measured by McGill Pain Questionnaire-Short Form (MPQ-SF) for patient on bed rest on day one, day three and day five post-operatively. Statistical (Mann- Whitney) findings between groups showed the experimental group significantly had less pain on day one and day five rather than the control group at 0.05 level using Pain Rating Intensity (PRI), Visual Analogue Scale (VAS) and Present Pain Intensity (PPI). Statistical (Friedman) tests within group showed that the patient had significantly decreased pain over time at level 0.05 using PRI, VAS and PPI. Statistical (Mann- Whitney) tests revealed that there was no significant difference when using analgesics between the two groups in five days post-operatively at milligram but comparing median showed experimental group used less analgesic than control group. Music therapy is simple, available, save and cheap effective intervention for pain management post-operatively. Pain management is one of the key roles of nursing and nurses can use music therapy as a simple intervention to reduce pain.

Enhancement of carer skills and patient function in the non-pharmacological management of frontotemporal dementia - FTD: a call for randomised controlled studies / Reforço da s habilidades dos cuidadores e da função do paciente no manejo não farmacológico da demência frontotemporal -DFT: necessidade para estudos clínicos randomizadose controlados

FTD is a unique condition which manifests with a range of behavioural symptoms, marked dysfunction in activities of daily living ADL and increased levels of carer burden as compared to carers of other dementias. No efficacious pharmacological interventions to treat FTD currently exist, and research on pharmacological symptom management isvariable. The few studies on non-pharmacological interventions in FTD focus on either the carer or the patients? symptoms, and lack methodological rigour. This paper reviews and discusses current studies utilising non-pharmacological approaches, exposing the clear need for more rigorous methodologies to be applied in this . Finally, a successful randomised controlled trial helped reduce behaviours of concern in dementia, and through implementing participation in tailored activities, the FTD-specific Tailored Activities Program TAP is presented. Crucially, this protocol has scope to target both the person with FTD and their carer. This paper highlights that studies in this area would help to elucidate the potential for using activities to reduce characteristic behaviours in FTD, improving quality of life and the caregiving experience in FTD.

A DFT é uma condição única que se manifesta por uma variedade de sintomas, principalmente em atividades da vida diária (AVD) e aumento da carga sobre os cuidadores em comparação aos cuidadores de outras demências. Não existe nenhuma intervenção farmacológica para tratamento da DFT até o momento e pesquisas sobre o manejo farmacológico dos sintomas são variáveis. Os poucos estudos em intervenção não farmacológica em DFT focam nos cuidadores ou emsintomas dos pacientes, faltando rigor metodológico. Este artigo revisa e discute os estudos atuais que utilizam abordagem não farmacológica, o que expõe a clara necessidade para metodologias mais rigorosas a serem aplicadas neste campo. Finalmente, um ensaio clinico randomizado bem sucedido ajudou na redução de comportamentos em demência, através da implementação da participação em atividades ajustadas, é apresentado o FTD-specific Tailored Activities Program (TAP). Este protocolo visa abordar tanto o paciente com DFT quanto seu cuidador. Este manuscrito evidencia que pesquisas dentro desta area ajudariam a elucidar o potencial em usar estas atividades para redução dos comportamentos característicos em DFt, melhorando a qualidade de vida e experiências dos cuidadores em DFT.

Intervenciones no farmacológicas en el insomnio primario: la evidencia de los ensayos clínicos controlados en los últimos diez años (1998-2008) / Non-pharmacological interventions in primary insomnia: controlled clinical trial findings (1998-2008)

Introducción: El insomnio es un trastorno del sueño que afecta al 10% de la población general e impacta a quien lo padece emocional, física y socialmente, por lo que es importante su adecuado diagnóstico y tratamiento. Objetivo: Describir los principales hallazgos de las intervenciones no farmacológicas sobre insomnio primario según la metodología de ensayos clínicos controlados. Método: Revisión sistemática durante febrero del 2009 en la base de datos de Ensayos Clínicos Controlados de Cochrane. Se seleccionaron artículos escritos en inglés, portugués o español publicados entre 1998 y 2008. Las palabras clave utilizadas fueron: primary insomnia, management, treatment y non pharmacological. Se descartaron artículos sobre insomnio secundario, con sólo resultados preliminares y aquellos escritos en idioma diferente a los establecidos. Al final se analizaron 37 artículos. Resultados: La modalidad de intervención más usada fue la combinación de técnicas cognitivo-conductuales (TCC). De manera general, todas las intervenciones tuvieron resultados positivos en la calidad del sueño. Las mejorías fueron de moderadas a altas y se mantuvieron a través del seguimiento. Según lo obtenido, el mejor tratamiento para el insomnio es la TCC, aunque otras opciones, como la máscara de luz, presentan resultados alentadores. Conclusiones: Hay hallazgos ciertos sobre los beneficios de las intervenciones no farmacológicas en el insomnio primario, con más estudios referentes a la TCC. Se plantea la necesidad de realizar estudios que evalúen dosis respuesta y la costo-efectividad de estas intervenciones...

Introduction: Insomnia is the most common sleep disorder and it affects approximately 10% of the world’s population causing a negative impact on sufferers’ emotional, physical, and social wellbeing. Several non−pharmacological treatments have been developed that appear to be effective. Objective: To analyze the main findings on primary insomnia. Methodology: During February 2009, a systematic review was undertaken using the Cochrane Database of Controlled Clinical Trials. A selection was made of articles written in English, Portuguese, and Spanish published between 1998 and 2008. The key words used were: primary insomnia, management, treatment and non−pharmacological. An analysis was carried out on 37 articles. Results: In general, all interventions had positive effects on the quality of sleep. With most of the combined techniques, the improvements were moderate−to−high and they were maintained through follow-up. According to the evidence gathered, the best non−pharmacological treatment was Cognitive Behavioral Therapy (CBT) although other intervention options such as Light Exposure produced encouraging results. The non−pharmacological approach gave better long−term results than pharmacological treatments. Conclusions: There is evidence of the benefits of non−pharmacological interventions for primary insomnia. Further research is necessary to evaluate the dose−response ratio and the cost−effectiveness of treatments...

Intervenções de grupo para sobrecarga de cuidadores de pacientes com demência: uma revisão sistemática / Group interventions focused on the burden of caregivers of patients with dementia: a systematic review

CONTEXTO: Além de orientações gerais sobre como lidar com o paciente, o cuidador familiar do sujeito com demência deve receber apoio para enfrentar as dificuldades do progresso da doença e aliviar a sua sobrecarga, seus sintomas depressivos e ansiosos. OBJETIVOS: Avaliar os modelos teóricos e metodológicos utilizados, assim como o efeito das intervenções de grupo na sobrecarga de cuidadores de pessoas com demência. MÉTODO: Busca nas bases de dados ISI, PubMed/Medline, SciELO e Lilacs de artigos sobre a eficácia de intervenções não farmacológicas com cuidadores de pessoas com demência, entre janeiro de 1999 e agosto de 2010, utilizando as palavras-chave: "demência", "cuidador", "sobrecarga", "intervenções não farmacológicas" e grupo/grupos". Os estudos encontrados foram organizados em duas categorias: intervenções psicoeducacionais ou psicossociais e psicoterapêuticas. RESULTADOS: Foram selecionados 37 artigos, sendo 31 de abordagem psicoeducacional ou psicossocial e 6, psicoterapêutica, com resultados estatisticamente significativos relacionados à eficácia das intervenções em grupo para a sobrecarga de cuidadores de pacientes com demência. Em 33 casos, houve melhora principalmente nos escores de depressão e estresse dos cuidadores. CONCLUSÃO: Apesar de apresentarem índices de eficácia, as intervenções em grupo para cuidadores de pessoas com demência ainda necessitam de estudos randomizados que visem à solução de problemas metodológicos importantes desse tipo de tratamento, como a falta de padronização das abordagens educacionais, o número de participantes ou o período de duração do grupo.

BACKGROUND: Besides receiving general orientations about how to deal with a patient with dementia, the caregiver needs support to cope with the progress of the disease and to alleviate his burden, as well as his depressive and anxious symptoms. OBJECTIVES: To evaluate the theoretical and methodological models used, as well as the effect of the group interventions on the burden of caregivers of people with dementia. METHOD: Search of articles at ISI, PubMed/Medline, SciELO and Lilacs about the efficacy of non pharmacological interventions with caregivers of patients with dementia, from January 1999 to August 2010, using the keywords: "dementia", "caregiver", "burden", "non pharmacological interventions", and "group/groups". The studies found were organized in two categories: psychoeducational or psychosocial interventions and psychotherapeutic interventions. RESULTS: Thirty seven articles were selected, 31 psychoeducational or psychosocial interventions and 6 psychoterapeutic ones, with statistically significant results related to the efficacy of group interventions on the burden of caregivers of people with dementia in 33 cases. There was an improvement especially on the scores of caregivers' depression and stress. DISCUSSION: In spite of efficacy, the group interventions for caregivers of people with dementia still need randomized studies aimed at the solution of important methodological problems of this kind of treatment, like the lack of standardized educational approaches, the number of participants or the duration of the group.